week 11 pharm

A patient is being switched from amitriptyline (Elavil) to citalopram (Celexa). Which statement made by the patient reflects understanding of patient education?

"I will not get as dizzy when I change positions after I switch medications."

Which statement made by a patient demonstrates a lack of understanding of patient teaching regarding phenothiazine drug therapy?

"It is okay to take this drug with a small glass of wine to help relax me."

A 51-year-old woman will be taking selective estrogen receptor modulators (SERMs) as part of the treatment for postmenopausal osteoporosis. The nurse reviews potential adverse effects with this patient, including the possible occurrence of A. pregnancy. B. breast cancer. C. stress fractures. D. venous thromboembolism.

ANS: D

A patient is being treated for primary amenorrhea. The nurse expects which drug to be used to treat this problem? A. oxytocin (Pitocin) B. estradiol transdermal (Estraderm) C. raloxifene (Evista) D. medroxyprogesterone (Provera)

ANS: D

A woman visits a health center requesting oral contraception. Which lab test is most important for the nurse to assess before the patient begins oral contraception therapy? A. Complete blood count B. Urinalysis C. Vaginal cultures D. Pregnancy test

ANS: D

During a follow-up visit, a patient who has been on estrogen therapy admits that she has continued to smoke cigarettes. The nurse will remind the patient that smoking while on estrogen may lead to increased A. incidence of nausea. B. tendency to bleed during menstruation. C. levels of triglycerides. D. risk for thrombosis.

ANS: D

The nurse recognizes that use of estrogen drugs is contraindicated in which of the following patients? A. A patient who has atrophic vaginitis B. A patient who has inoperable prostate cancer C. A woman who has just given birth and wants to prevent postpartum lactation D. A woman with a history of thrombophlebitis

ANS: D

The nurse is preparing to administer the contraceptive form of medroxyprogesterone (Depo-Provera). What route should be planned? A. Oral B. Intramuscular C. Vaginal D. Transdermal

ANSl B

Which medication is most likely to promote follicular maturation in an infertile female patient? A. Clomiphene (Clomid) B. Ethinyl estradiol (Estinyl) C. Progesterone (Prometrium) D. Choriogonadotropin alfa (Pregnyl)

A. Clomiphene (Clomid) Clomiphene facilitates follicular maturation by promoting the release of follicle-stimulating hormone and luteinizing hormone from the pituitary gland. Ethinyl estradiol is a steroidal estrogen used in hormone replacement. Progesterone is more likely to be used to maintain a pregnancy. Choriogonadotropin alfa causes ovulation from mature follicles.

A female patient who is 65 years old receives hormonal therapy. Which therapy will increase the risk of endometrial cancer in this patient? A. Estrogen B. Progesterone C. No hormone-replacement therapy D. Progesterone-estrogen combination

A. Estrogen The prolonged use of unopposed estrogens by postmenopausal women is related to an increased risk of endometrial cancer because, when they are used alone, estrogens cause endometrial proliferation and hyperplasia. Estrogen in combination with progesterone causes little or no risk of uterine cancer because the progestin reduces the risk of endometrial cancer by decreasing estrogen-mediated endometrial proliferation.

A female patient is taking estrogen with progesterone. What instruction should the nurse include in patient teaching to facilitate the monitoring of the risks associated with this therapy? A. Have a yearly mammogram B. Perform weight-bearing exercise C. Have tests for serum cholesterol D. Report missed menstrual periods

A. Have a yearly mammogram Estrogen in combination with progesterone increases the risk of breast cancer, so the nurse instructs the patient to have a yearly mammogram. The risk of osteoporosis decreases for women who take estrogen therapy. Although patients taking estrogen with progestin are at increased risk of thromboembolic events, the effect on serum lipids is unclear. Pregnancy is generally not a concern when women take this combination as hormone replacement therapy, and missed periods are common.

A patient is receiving IV methylergonovine (Methergine) after a vaginal delivery. Which postpartum assessment is the nurse's priority to prevent complications of therapy? A. Hypertension B. Hypoglycemia C. Decreased lochia D. Uterine contractions

A. Hypertension The therapeutic goal is contraction of the fundus to stop postpartum bleeding. Hypertension is likely to increase the severity of postpartum bleeding, so the prevention of hypertension is the nurse's priority for a postpartum patient receiving an ergot alkaloid because ergot alkaloids can increase blood pressure. Hypoglycemia is not an adverse effect of methylergonovine. Decreased lochia rubra is the therapeutic goal. Uterine contractions are expected during methylergonovine therapy because this is the mechanism of action behind the cessation of postpartum uterine bleeding.

Finasteride (Proscar) is effective in the treatment of benign prostatic hypertrophy because it does what? A. Inhibits growth of the prostate B. Increases penile blood flow C. Relieves male urine retention D. Relaxes the prostatic sphincter

A. Inhibits growth of the prostate Finasteride promotes the regression of prostate epithelial tissue, which results in decreased mechanical obstruction of the urethra through the inhibition of 5-alpha-reductase, the enzyme responsible for converting testosterone to 5-alpha-dihydrotestosterone. Finasteride has no effect on penile perfusion or urinary stasis. The prostatic sphincter does not exist.

Which contraceptive device is most likely to prevent the transmission of sexually transmitted diseases? A. Male condom B. Spermicidal agent C. Intrauterine device D. Cervical diaphragm

A. Male condom Male condoms are most likely to prevent the transmission of a sexually transmitted disease because they provide the most barrier protection.

Which medication is not indicated for a patient who has undergone a hysterectomy and bilateral oophorectomy? A. Megestrol (Megace) B. Alendronate (Fosamax) C. Calcium citrate (Citracal) D. Estradiol transdermal (Vivelle-dot)

A. Megestrol (Megace) Megestrol, a progestin, is not indicated in hormonal therapy for patients who have undergone a total hysterectomy; instead, it is indicated in the palliative management of recurrent, inoperable, or metastatic endometrial or breast cancer. The primary role of progestin in hormonal therapy is to counterbalance the risk of estrogen-mediated endometrium hyperplasia. Because the patient does not have an endometrium since undergoing hysterectomy, she does not need this medication. Alendronate and calcium citrate for osteoporosis and estradiol transdermal may be suitable therapies after hysterectomy.

Which medication is most likely to decrease the effectiveness of norethindrone and ethinyl estradiol (Ortho-Novum)? A. Rifampin (Rifadin) B. Furosemide (Lasix) C. Acetaminophen (Tylenol) D. Calcium citrate (Citracal)

A. Rifampin (Rifadin) A variety of drugs, including rifampin, ritonavir, troglitazone, carbamazepine, phenobarbital, phenytoin, tetracyclines, and ampicillin, can decrease the effectiveness of oral contraceptives.

A male patient has mild prostatic enlargement. Which medication should the nurse administer to the patient as initial therapy? A. Tamsulosin (Flomax) B. Stanozolol (Winstrol) C. Minoxidil (Rogaine) D. Finasteride (Proscar)

A. Tamsulosin (Flomax) Tamsulosin, an alpha1-receptor blocker, is indicated in the treatment of mild prostatic enlargement. Drugs in this class work by relaxing smooth muscle in the bladder neck, prostate capsule, and prostatic urethra, leading to decreased dynamic obstruction.

The patient is to receive medroxyprogesterone (Depo-Provera) 500 mg, weekly, intramuscularly, on Mondays for 4 weeks as part of palliative therapy for cancer. The medication is available in vials of 400 mg/mL. How many milliliters will the nurse draw up and administer with each injection? Round to the nearest tenth

ANS: 1.3 mL

A female patient who lives in New York City is preparing to take a plane trip to Australia. She has been taking the SERM raloxifene (Evista). The nurse will provide which instructions to this patient? A. She should stop taking the drug at least 72 hours before the trip. B. She must remember to take this drug with a full glass of water each morning. C. She should increase the calcium supplements that she takes with the drug. D. No change in interventions is needed.

ANS: A

A patient wants to try an oral soy product to relieve perimenopausal symptoms. The nurse will assess the patient's medication history for potential drug interactions, including A. thyroid replacement therapy. B. oral anticoagulant therapy. C. nonsteroidal antiinflammatory drugs. D. beta blockers.

ANS: A

The nurse is teaching a patient about the adverse effects of fertility drugs such as clomiphene (Clomid). Which is a potential adverse effect of this drug? A. Dizziness B. Drowsiness C. Dysmenorrhea D. Increased appetite

ANS: A

When reviewing the risk factors for osteoporosis, the nurse recognizes that which of the following is considered a risk factor? A. White or Asian race B. African American race C. History of participation in active sports D. Obesity

ANS: A

A patient taking an oral contraceptive should be aware of potential drug interactions with which medications? Select all that apply. A. cephalexin (Keflex) B. guaifenesin (Robitussin) C. warfarin (Coumadin) D. isoniazid (INH) E. ibuprofen (Motrin) F. theophylline (Uniphyl)

ANS: A, C, D, F

A patient who is taking the bisphosphonate alendronate (Fosamax) has been instructed to lie flat in bed for 2 days after having plastic surgery. Which intervention is appropriate at this time? A. She should continue to take the alendronate with water. B. She should not take the alendronate until she can sit up for 30 minutes. C. She can take the medication with breakfast. D. She should stop taking the medication 72 hours before her surgery.

ANS: B

The nurse notes in the patient's medication orders that the patient is taking the tocolytic drugs terbutaline (Brethine). Based on this finding, the nurse interprets that the drug has been ordered for which problem? A. Prevention of preterm labor in the 15th week of pregnancy B. Prevention of preterm labor in the 22nd week of pregnancy C. Stimulation of contractions in prolonged labor D. Stimulation of ovulation as part of infertility treatments

ANS: B

The nurse should instruct a patient who will be taking bisphosphonate alendronate (Fosamax) to take this medication at which time? A. In the evening just before bedtime B. In the morning with an 8-ounce glass of water C. With the first bite of the morning meal D. Between meals on an empty stomach

ANS: B

A patient is receiving oxytocin (Pitocin) to induce labor. During administration of this medication, the nurse will also implement which action? A. Giving magnesium sulfate along with the oxytocin B. Administering the medication in an intravenous bolus C. Administering the medication with an IV infusion pump D. Monitoring fetal heart rate and maternal vital signs every 6 hours

ANS: C

The nurse is providing teaching for a patient who is to receive estrogen replacement therapy. Which statement is correct to include in the teaching session? The patient should A. double-up on the medication if a dose is missed. B. not be concerned about breast lumps or bumps that occur. C. report any weight gain of more than 5 pounds per week. D. take the medication on an empty stomach to enhance absorption.

ANS: C

When considering the various types of contraceptive drugs, the nurse is aware that which type most closely duplicates the normal hormonal levels of the female menstrual cycle? A. Monophasic B. Biphasic C. Triphasic D. Long-acting

ANS: C

When couples are treated for infertility with ovulation-inducing drugs, the nurse will include instruction about the increased likelihood of A. severe weight gain. B. irregular menses. C. multiple births. D. alopecia.

ANS: C

While discussing options for osteoporosis prevention, a patient asks if she will be using estrogen patches. What is the nurse's best response? A. "Estrogen patches are still the first choice for osteoporosis prevention." B. "Estrogen patches are often used as long-term therapy for osteoporosis prevention." C. "Estrogen patches are associated with a high risk for cardiovascular problems and are not the first choice for osteoporosis prevention." D. "Estrogen patches will be prescribed if the patient prefers patches to oral medications."

ANS: C

What is a contraindication to the use of nandrolone (Deca-Durabolin)? A. Metastatic breast cancer B. Androgen-sensitive tumor C. Male hormone replacement D. Reverse muscle debilitation

B. Androgen-sensitive tumor The use of nandrolone is contraindicated in the presence of androgen-sensitive tumors because nandrolone is a synthetic androgen, or an anabolic steroid; it is withheld from the patient because it would promote growth of the tumor. Metastatic breast cancer is an indication for the use of nandrolone. Male hormone replacement and debilitation are indications for the use of other synthetic androgens.

To be a suitable candidate for clomiphene (Clomid) therapy, the patient must have what? A. Endometriosis B. At least one ovary C. A stable personality D. Estrogen deficiency

B. At least one ovary For clomiphene to be effective, the patient needs at least one ovary because the drug stimulates maturation of the ovarian follicle, leading, it is hoped, to ovulation and an increased chance of conception. Endometriosis, extrauterine growth of endometrial tissue, can cause infertility. It has no effect on follicular maturation unless the extrauterine endometrial tissue grows on the ovary. Depending on the individual patient and her infertility problem, some infertility clinics require a psychological examination, but clomiphene may be one of the first treatments used to facilitate conception in infertile woman. Estrogen-replacement therapy is not an effective fertility treatment.

Which benefit is a therapeutic result of administering synthetic androgens to a patient? A. Reversal of male infertility B. Enhanced male libido C. Relief of urinary hesitancy D. Increased duration of erection

B. Enhanced male libido Androgen-replacement therapy is indicated in the treatment of testicular failure to improve the male libido; however, it does not reverse male infertility, relieve urinary hesitancy, or increase the duration of an erection.

Which medication requires the use of gloves by a female nurse who is handling or administering it? A. Vardenafil (Levitra) B. Finasteride (Proscar) C. Stanozolol (Winstrol) D. Tamsulosin (Flomax)

B. Finasteride (Proscar) Women, especially pregnant women, are instructed by the manufacturer to wear gloves as a means of avoiding contact with finasteride because the drug is teratogenic. The nurse may handle safely vardenafil, stanozolol, and tamsulosin without wearing gloves.

Which method of contraception requires the least amount of patient adherence to therapy for therapy to be effective? A. Medroxyprogesterone (Depo-Provera) B. Progesterone-filled intrauterine device (IUD) C. Norelgestromin-ethinyl estradiol transdermal patch D. Norethindrone and ethinyl estradiol (Ortho-Novum 7/7/7)

B. Progesterone-filled intrauterine device (IUD) The progesterone-filled IUD, which is inserted by a physician, is replaced on a yearly basis to prevent conception, meaning that the patient must adhere to the yearly schedule for replacement. Medroxyprogesterone (Depo-Provera) requires the patient to schedule an intramuscular injection on a quarterly basis, or every 3 months. The transdermal patch requires the patient to remove the old patch and apply a new patch once a week. The triphasic oral contraceptive requires the greatest degree of patient adherence because the pills are taken for 21 or 28 days per cycle.

A male patient who has had a toe amputated because of peripheral arterial disease (PAD) is seeking a prescription for vardenafil (Levitra). Before administering this medication, the nurse reviews the results of diagnostic tests and patient assessments that might be affected by the medication. Which parameter(s) should the nurse evaluate to prevent aggravation of the disease process? (Select all that apply.) A. Hemoglobin B. Serum sodium C. Liver enzymes D. Serum calcium E. Peripheral pulses

B. Serum sodium D. Serum calcium E. Peripheral pulses The nurse evaluates the patient's serum sodium, serum calcium, and peripheral pulses before administering vardenafil to help prevent aggravation of PAD. Each of these parameters may be affected by the administration of vardenafil. Increased serum sodium may increase water retention and blood pressure, exacerbating hypertension; the combined effect of these changes may increase damage to the intimal walls of vessels, accelerating vascular damage and increasing the risk of injury to fragile tissues. An abnormal calcium level may increase the risk of cardiac dysrhythmias, impairing tissue oxygenation as a result. Peripheral pulses must be evaluated in the patient with PAD because vardenafil may cause hypotension, and lower blood pressure can result in impaired peripheral perfusion. Vardenafil is unlikely to alter the patient's hemoglobin. Liver enzymes may be affected by vardenafil, but such changes are more likely to affect the metabolism of vardenafil than the PAD.

Which factor has the greatest potential to increase the risk of thromboembolic phenomena in a patient taking norethindrone and ethinyl estradiol (Loestrin)? A. Consumption of saturated fats B. Smoking heavily every day C. Increased body mass index (BMI) D. Sedentary lifestyle

B. Smoking heavily every day Women taking oral contraceptives are at increased risk of thromboembolic events if they smoke heavily or have a history of thromboembolism; this higher risk is partially due to an increase in circulating levels of clotting factors. Consumption of saturated fats is likely to increase the risk of a thromboembolic event in a patient who takes an oral contraceptive, but not as much as smoking. Sedentary living increases the risk of several health problems and can contribute to the development of thromboemboli, but that risk is secondary to the risk resulting from concurrent smoking and use of oral contraceptives.

The nurse notes lithium on a patient's drug history upon admission. Which condition would the nurse suspect that this patient has been diagnosed with?

Bipolar disorder

Selective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants (TCAs) both function by which mechanism?

Blocking the reuptake of neurotransmitters at nerve endings

A patient is being started on sildenafil (Viagra) and asks how soon before having sexual activity should he take the medication. When is the best time for the patient to take the medication? A. Immediately before sexual activity B. 30 minutes before sexual activity C. 1 hour before sexual activity D. 2 hours before sexual activity

C. 1 hour before sexual activity Sildenafil is usually prescribed to be taken about 1 hour before sexual activity.

A patient receives a prescription for minoxidil (Rogaine) to restore hair growth, and the nurse establishes the nursing diagnosis of risk for injury related to the adverse effects of therapy. What is the best intervention for the nurse to include in the plan of care? A. Rest to manage headaches B. Avoidance of all sodium-rich foods C. Adequate hydration D. The need to report erythema and pruritus

C. Adequate hydration Minoxidil can cause orthostatic hypotension, so the nurse instructs the patient to maintain adequate hydration to help prevent orthostatic hypotension and dizziness, which increase the risk of patient injury. The nurse also instructs the patient to stand slowly and to avoid hazardous activities until the full effects of this medication are known. Resting is a reasonable nursing intervention to help prevent a headache but is unrelated to the patient's risk for injury. Avoidance of sodium and reporting of skin changes have a weaker relationship to the prevention of patient injury than do avoidance of hypotension and dizziness. Avoiding sodium can help prevent or diminish edema and may reduce the risk of trauma to edematous tissues. Reporting of skin changes can help prevent tissue trauma; however, erythema and pruritus are common adverse effects of therapy and do not need to be reported unless they become severe.

Which hormonal change is responsible for clinical indicators of menopause? A. Increase in prolactin level B. Increase in progesterone level C. Decline in estrogen production D. Decline in luteinizing hormone (LH)

C. Decline in estrogen production The decline in estrogen production by the ovaries is associated with clinical indicators of menopause, including vasomotor instability, vaginal dryness and atrophy, and declining bone density. This decline is caused because the ovarian follicles, which are the primary source of estrogen, decline as women grow older.

Which hormonal change causes the breakdown of the endometrium and resultant menstrual bleeding? A. Increased levels of estrogens B. Increased luteinizing hormone (LH) C. Decreased level of progesterone D. Decreased level of follicle-stimulating hormone (FSH)

C. Decreased level of progesterone The breakdown of the endometrium and the resultant menstrual bleeding are caused by the fall of the progesterone level at the end of the menstrual cycle. The decline in estrogens plays a role, but the decrease in progesterone is responsible for bleeding. The increase in estrogens after menstruation is responsible for the restoration of the endometrium. LH and FSH are not directly related to menstrual bleeding.

A postmenopausal patient who has undergone a total abdominal hysterectomy needs treatment for osteoporosis. Which prescription should the nurse administer as suitable therapy? A. Raloxifene (Evista) by mouth 60 mg/wk B. Alendronate (Fosamax) by mouth 5 mg/wk C. Estradiol transdermal (Climara) 0.025-mg patch/wk D. Calcitonin (Miacalcin) 200 units/day subcutaneously

C. Estradiol transdermal (Climara) 0.025-mg patch/wk The prescription for the patient receiving estrogen-replacement therapy involving the use of a transdermal patch is within the dosing range for the medication. Estrogen is effective and is indicated in the treatment of osteoporosis for women who are willing to accept the risks of therapy. Raloxifene is administered at a dosage of 60 mg/day, alendronate is administered at a dosage of 35 mg/week or 5 mg/day, and calcitonin is administered at a dosage of 200 units nasally.

Which comorbidity must be ruled out before a postmenopausal patient seeking hormone-replacement therapy may use estradiol (Estrace)? A. Chloasma B. Hypertension C. Fibroid tumors D. Esophageal reflux

C. Fibroid tumors Fibroid tumors must be ruled out before a postmenopausal patient may be prescribed estradiol therapy because the presence of fibroid tumors indicates that the patient has a uterus and because fibroid tumors are associated with uterine bleeding. If the patient has a uterus, hormone replacement therapy must include a progestin to prevent endometrial hyperplasia. Hypertension, reflux, and discoloration of the face are not contraindications to estradiol therapy.

Which patient assessment finding should the nurse expect after the vaginal administration of dinoprostone (Cervidil)? A. Midline fundus B. Decreased pain C. Softened cervix D. Strong contractions

C. Softened cervix Dinoprostone is indicated to ripen the cervix in preparation for labor induction. If labor induction is attempted without sufficient preparation of the cervix, cervical injury may occur. A midline fundus is expected during the postpartum period. Dinoprostone is without analgesic properties and should not stimulate uterine contractions.

An increased progesterone level promotes a pregnancy by doing what? A. Thinning the cervical mucosa B. Thickening the vaginal mucosa C. Suppressing uterine contractions D. Stimulating the development of breast tissue for lactation

C. Suppressing uterine contractions The progesterone level increases during pregnancy and helps sustain a pregnancy by suppressing uterine contractions. Estrogen thins the cervical mucosa, thickens the vaginal mucosa, and stimulates the development of breast tissue.

What information should the nurse include when preparing an educational session about cancer risks in postmenopausal women? A. Estrogen monotherapy increases the risk of breast cancer. B. Monotherapy with a progestin increases breast cancer risk. C. Unopposed estrogen increases the risk of endometrial cancer. D. Estradiol with progestin increases the risk of endometrial cancer.

C. Unopposed estrogen increases the risk of endometrial cancer. The prolonged use of estrogen alone is associated with an increased risk of endometrial cancer; however, when estrogen is combined with progestin, the risk diminishes. Estrogens used alone are not associated with increased risk of breast cancer; however, estrogen in combination with progestin is associated with an increased risk of breast cancer.

Which laboratory test should be monitored frequently to assess for a potential life-threatening adverse reaction to clozapine (Clozaril)?

Complete blood count

A patient at 26 weeks' gestation who has diabetes mellitus starts to experience preterm labor. Which treatment is the best initial therapy for the prevention of uterine contractions and complications in this patient's pregnancy? A. Ritodrine (Yutopar) B. Magnesium sulfate C. Terbutaline (Brethine) D. Bedrest and hydration

D. Bedrest and hydration The best initial therapies for preterm labor (bedrest and hydration) do not involve the use of medication. Bedrest and hydration are especially good choices in this patient because they do not carry the risk of increased blood sugar that terbutaline therapy does. Hydration can be an effective therapy for preterm labor, but its mechanism of action is unknown. Because pressure on the cervix or cervical incompetence can stimulate uterine contractions, bedrest may also be effective in relieving pressure on the cervix and inhibiting uterine activity. Generally terbutaline, the drug of choice for preterm labor, is used after conservative measures have failed. Magnesium sulfate is used as an off-label therapy for preterm labor; ritodrine is generally reserved for when conservative measures and terbutaline have failed.

Which type of oral contraceptive (OC) delivers hormones for more than 30 days? A. Biphasic B. Triphasic C. Monophasic D. Extended-cycle

D. Extended-cycle Extended-cycle oral contraceptives deliver hormones for 84 to 365 consecutive days, shortening or eliminating the hormone-free period. Biphasic OCs, which deliver estrogen in a fixed amount for 21 or 28 days, contain a low dose of progestin for the first 10 days and a higher dose of progestin for the remainder of the cycle. Triphasic OCs deliver three different estrogen-progestin combinations over the course of the cycle. Monophasic OCs deliver an unchanging combination of estrogen and progestin.

A female patient with strep throat is taking amoxicillin with clavulanate (Augmentin) to eliminate the infection. Because the patient also takes an oral contraceptive (OC), the nurse instructs her to use a different method of birth control for how long? A. For at least 6 weeks, starting at the end of the antibiotic regimen B. Until three throat cultures have been negative for the pathogen C. During the entire period she is taking the antibiotic D. For at least a month during and after starting the antibiotic

D. For at least a month during and after starting the antibiotic Because antibiotics, especially penicillins and cephalosporins, can impair the action of OCs, the nurse instructs the patient to use another method of birth control for at least 1 month during and after starting the antibiotic.

Which assessment finding indicates that a patient is a suitable candidate for oxytocin (Pitocin) therapy? A. Vaginal bleeding at 38 weeks' gestation B. Radiographic confirmation of cephalopelvic disproportion C. Absence of cervical ripening at 42 weeks' gestation D. Ineffective contractions in a term pregnancy

D. Ineffective contractions in a term pregnancy A patient whose pregnancy is full term but who has ineffective contractions is a suitable candidate for oxytocin therapy to augment the strength and increase the frequency of contractions. Vaginal bleeding in a patient near term is an obstetric emergency, and oxytocin is contraindicated because it is likely to increase the bleeding, increase and strengthen the contractions, and cause fetal distress. In the patient with cephalopelvic disproportion, the fetus's head may be too large for the patient's pelvis; harm to both patient and fetus could occur if oxytocin were administered. Oxytocin is indicated for the induction of labor in a post-term patient, but the patient must have a soft cervix.

Which medication is suitable therapy for oral contraception in women who cannot take estrogen? A. Megestrol (Megace) B. Estropipate (Ortho-Est) C. Estrone (Estrone Aqueous) D. Medroxyprogesterone (Provera)

D. Medroxyprogesterone (Provera) Because it prevents follicular maturation and ovulation, medroxyprogesterone is a suitable oral contraceptive for women who cannot take estrogen. Megestrol is unsuitable because it is indicated in the palliative treatment of endometrial and breast cancers. Estropipate and estrone are synthetic estrogens.

A female patient complains of irritability, fatigue, and decreased ability to enjoy things that she used to enjoy. Which contraceptive should this patient avoid using? A. Cervical cap with spermicidal jelly B. Male condom with spermicidal jelly C. Medroxyprogesterone (Depo-Provera) D. Norethindrone and ethinyl estradiol (Necon)

D. Norethindrone and ethinyl estradiol (Necon) The patient has clinical indicators consistent with depression, so the nurse encourages her to avoid using oral contraceptives to prevent pregnancy because these drugs can cause depression. The cervical cap, male condom, and progestin are reasonable alternatives for the prevention of pregnancy in this patient.

Which patient is receiving a proper dose of a medication used for male health? A. Sildenafil (Viagra) 50 mg injected into the penile shaft B. Finasteride (Propecia) 5 mg/day by mouth for baldness C. Transdermal testosterone (Testoderm) 4 mg/day applied to the back D. Testosterone cypionate (Depo-Testosterone) 300 mg IM each month

D. Testosterone cypionate (Depo-Testosterone) 300 mg IM each month The dosage range for testosterone cypionate is 200 to 400 mg IM every second or fourth week. Sildenafil is administered by mouth; finasteride is administered in a dosage of 1 mg/day; and transdermal testosterone must be applied to the scrotum.

Which statement regarding endogenous testosterone is true? A. It is used to treat alcoholic hepatitis. B. It helps eliminate nitrogen from the body. C. It promotes male catabolic metabolism. D. The seminiferous tubules produce testosterone.

D. The seminiferous tubules produce testosterone. Testosterone is produced in the testicles, in the interstitial cells of the seminiferous tubules. Oxandrolone is used to treat alcoholic hepatitis. Testosterone helps retain nitrogen in the body and promotes anabolic metabolism.

The nurse monitors a patient taking an antipsychotic medication for extrapyramidal side effects. What is the nurse assessing for in the patient?

Dystonia

Which activity should the patient be cautioned to avoid while taking an MAO inhibitor?

Eating aged cheese

A patient diagnosed with depression is started on a TCA after failure to improve symptoms on an SSRI. The nurse should include which teaching point when educating the patient about the new medication?

There is a risk of toxicity when this medication is taken with alcohol.

What is another approved and indicated use for bupropion (Zyban), a second-generation antidepressant?

Smoking cessation

A patient currently prescribed duloxetine (Cymbalta) comes to the health clinic complaining of restlessness, agitation, diaphoresis, and tremors. The nurse suspects serotonin syndrome and questions the patient regarding concurrent use of which substance?

St. John's wort

A patient diagnosed with an anxiety disorder has been using lorazepam (Ativan) but finds the side effect of drowsiness to be interfering with life. Which anxiolytic medications might be a better option for this patient?

buspirone (BuSpar)

What atypical antipsychotic medication would the nurse anticipate a provider prescribing for treatment of refractory schizophrenia?

risperidone (Risperdal)